From an integrative perspective of the "person in situation," and from an interdisciplinary approach, we cannot address the issue of prevention without trying to locate it in its proper context. Mental health, which is previously defined and implicit in this type of approach, is not an absolute value for us, and it can be evaluated in terms of the quality of social behavior.
This behavior, its operability, or its deterioration, is closely linked to socio-economic and family factors, which intervene or determine, either positively or negatively, an active adaptation to reality, where the individual engages with the environment in a creative and modifying relationship.
From this perspective, the central issue is not the methodology of prevention but rather the strategies for changing the socio-economic structure from which mental illness emerges. The patient is the spokesperson for the conflicts and tensions of their immediate group, the family. But, it is also for this reason that the patient is the symbol and the repository of the alienated aspects of their social structure, a spokesperson for insecurity and the climate of uncertainty. To cure them is to assign them a new role, that of agent of change, and for us to transform ourselves into elements of change as well.
It is important to note, from a perspective focused on prevention techniques, the instrumental and operational nature of the family group as the support of the social organization, the primary unit of interaction, which is established based on an interplay of differentiated roles.
Its structural nature arises from the necessary interdependence of the roles corresponding to the basic triangular situation: father, mother, and child, emerging from the functional and biological relationships and differences. This basic and universal triangular situation, with its potential cultural variables, determines the model that family interrelations will follow.
The mentioned structural nature of the family group allows us to approach it as a unit of analysis, in the sense that we can engage with it as a diagnostic, prognostic, therapeutic, and prophylactic unit.
As a basic unit of interaction, the family appears as the socializing instrument, within which the individual acquires their identity, their individual position within the interactional network. The functionality and mobility of this position will indicate the degree and nature of adaptation within that group context, of which each individual is the spokesperson.
When, within this structure, which acts as a vehicle for cultural norms, mediating between the individual and reality through relational ties, illness emerges as a new quality in the interaction process, we understand this deviant behavior as an anomaly that affects the entire structure in its intra-systemic or inter-systemic process of interrelation.
The illness is the emerging quality, a new quality that refers us, as investigators, to an implicit, underlying situation, shaped by a particular modality of group interaction, which at that moment becomes alienating. The patient is the spokesperson through which the pathological situation manifests itself, affecting the whole structure.
That is, the spokesperson (patient) is the vehicle through which the implicit process causing the illness begins to manifest.
We can affirm that any implicit process manifests itself through the appearance, within the observation field, of a new quality in that field, which we call emerging, and which refers us, as investigators, to an implicit occurrence, or in other words, to an order of underlying facts, subjected to a constant process of structuring and de-structuring.
In a previous work, we stated that madness is the expression of our inability to endure and process a certain amount of suffering. When a neurosis or psychosis emerges within the family group, we discover that a certain degree of insecurity had previously settled within that group, rendering it impotent.
This dynamically means that a member of the family group assumes a new role, becoming the spokesperson and repository of the group's anxiety. They take on the pathological aspects of the situation in an interactional process of assigning and assuming roles, involving both the individual recipient and the ones assigning them. The stereotype forms when the projection of pathological aspects arising from this insecurity is massive.
The individual becomes paralyzed, fails to process such intense anxiety, and becomes ill (at which point there is a shift from the quantitative to the qualitative).
From this moment on, the cycle of forming a pathological security mechanism is completed, triggered by increased tensions, which consists of the massive deposition, followed by the segregation of the repository due to the dangerousness of the deposited contents.
The interplay of roles is characterized in this situation by its rigidity and immobility, no longer governed by a law of complementarity but by a principle of supplementarity. That is, once the interactional process has established a stereotyped and repetitive pattern, an entire feedback system is put at the service of that pattern.
As a prevention strategy for the emergence of pathological situations within the family group, we will propose some clarification techniques aimed at reinforcing aspects of mobility and operability within the group. Our goal is to create an adaptive and creative security device that enables the group to face the situations of change that generate insecurity.
As approaches, we will follow the proposals in our inverted cone scheme, where we categorize the modes of interaction observed in any task group within the vectors of belonging, cooperation, pertinence, communication, learning, and tele. The operational group and the family group are susceptible to the same definition: a set of people gathered by constant time and space and articulated by their mutual internal representation, who implicitly or explicitly propose a task, which constitutes their purpose. In this case, within the family group, we will add kinship ties to the constants of time and space. The family group's task is, as previously stated, the socialization of the individual, providing a framework and foundation for achieving active adaptation to reality, in which both the individual and the environment undergo a permanent dialectical interplay.
This model can provide a reference framework for the operator, whether they work in what is generally understood as primary, secondary, or tertiary prevention.
The clarification and operational handling of the vectors of belonging, cooperation, pertinence, communication, learning, and tele will allow the group unit to address the anxieties triggered by the situations of change that any family group necessarily goes through.
Among these situations, we are particularly interested in highlighting two critical ones: adolescence, marked by the transition from the child's role to the adult's role, and entering old age, characterized in our family structure by the loss of operational roles. We see that in both cases, there are significant alterations in the process of assigning and assuming roles within the family group.
We understand belonging as the feeling of being part of a group, identifying with the events and vicissitudes of that group. Through belonging, group members visualize each other as such, feel the other members included in their internal world, and internalize them. Through this belonging, they can count on each other and plan the group's task, including them. Belonging allows the establishment of the group's identity and the individual's identity as part of the group. For Sartre, any group that does not reflect, as an act, upon itself runs the risk of falling into what he calls "seriality." The individual who sees themselves as a member of a group, as belonging, acquires an identity, a basic reference that allows them to situate themselves and develop strategies for change. However, optimal belonging, like the other vectors of approach, is not "given," as consanguinity ties might be, but acquired, something achieved by the group as such.
Through belonging, cooperation, and mainly pertinence, in which communication, learning, and tele play a role, the group reaches totalization in the sense of becoming in its process, in its task, in its work as a group.
Following Sartre's view of the group as an act, as something that constitutes itself permanently as a group, we must consider the fundamental role that internal dialectic plays in establishing the constitutive relationships of the group. This is why we have emphasized in this definition the fact that the group is a set of people articulated by their mutual internal representation. This representation follows the characteristics of the dramatic model. The internal dialectic is the dialectic of the internal group whose chronicle – always following the mentioned model – is unconscious fantasy. Through this dialectic, each member achieves a totalization, a synthesis, that constitutes the group as a group. Put in Sartrean terms, this internal and external dialectic leads the group to transcend seriality, understood as dispersion.
The task, the group's sense, and the mutual internal representation made in relation to the task constitute the group as a group. The task is the group's march towards its goal; it is a becoming and a dialectical doing towards an end, a praxis, and a trajectory.
In a family group, cooperation is based on differential roles. We emphasize the heterogeneity that roles within the family must exhibit. This heterogeneity is supported by the biological and functional differences on which a family structure must be configured. The family, as we have said, thus becomes the realm of learning biological roles and social functions.
Only through heterogeneity can we achieve the complementarity needed in an operational group, that is, in a group capable of instrumental and situational achievements.
A clarification of the group's communication networks, along with addressing family mysteries and analyzing ideologies, will allow, along with the adjustment between internal images and external reality, the resolution of misunderstandings, thus creating the appropriate climate for the family task.
Bibliography Sartre, J.P., Critique of Dialectical Reason, Losada, Buenos Aires, 1963
Lapassade, G., Institutions, Groups, and Organizations, Gauthier-Vilars, Paris, 1968.
Pichon-Rivière, E., "Family Groups: An Operational Approach," in this volume.
__,"Praxis and Psychiatry," ibid.
__,"Use of Tofranil in Individual and Group Psychotherapy," ibid.